Risk factors for COVID-19 infection, disease severity and related deaths in Africa: a systematic review

Hailay Abrha Gesesew, Digsu Negese Koye, Dagnachew Muluye Fetene, Mulu Woldegiorgis, Yohannes Kinfu, Ayele Bali Geleto, Yohannes Adama Melaku, Hassen Mohammed, Kefyalew Addis Alene, Mamaru Ayenew Awoke, Mulugeta Molla Birhanu, Amanuel Tesfay Gebremedhin, Yalemzewod Assefa Gelaw, Desalegn Markos Shifti, Muluken Dessalegn Muluneh, Teketo Kassaw Tegegne, Solomon Abrha, Atsede Fantahun Aregay, Mohammed Biset Ayalew, Abadi Kahsu GebreKidane Tadesse Gebremariam, Tesfaye Gebremedhin, Lemlem Gebremichael, Cheru Tesema Leshargie, Getiye Dejenu Kibret, Maereg Wagnew Meazaw, Alemayehu Berhane Mekonnen, Dejen Yemane Tekle, Azeb Gebresilassie Tesema, Fisaha Haile Tesfay, Wubshet Tesfaye, Befikadu Legesse Wubishet, Berihun Assefa Dachew, Akilew Awoke Adane

Research output: Contribution to journalArticlepeer-review

45 Citations (Scopus)
52 Downloads (Pure)


OBJECTIVE: The aim of this study was to provide a comprehensive evidence on risk factors for transmission, disease severity and COVID-19 related deaths in Africa.

DESIGN: A systematic review has been conducted to synthesise existing evidence on risk factors affecting COVID-19 outcomes across Africa.

DATA SOURCES: Data were systematically searched from MEDLINE, Scopus, MedRxiv and BioRxiv.

ELIGIBILITY CRITERIA: Studies for review were included if they were published in English and reported at least one risk factor and/or one health outcome. We included all relevant literature published up until 11 August 2020.

DATA EXTRACTION AND SYNTHESIS: We performed a systematic narrative synthesis to describe the available studies for each outcome. Data were extracted using a standardised Joanna Briggs Institute data extraction form.

RESULTS: Fifteen articles met the inclusion criteria of which four were exclusively on Africa and the remaining 11 papers had a global focus with some data from Africa. Higher rates of infection in Africa are associated with high population density, urbanisation, transport connectivity, high volume of tourism and international trade, and high level of economic and political openness. Limited or poor access to healthcare are also associated with higher COVID-19 infection rates. Older people and individuals with chronic conditions such as HIV, tuberculosis and anaemia experience severe forms COVID-19 leading to hospitalisation and death. Similarly, high burden of chronic obstructive pulmonary disease, high prevalence of tobacco consumption and low levels of expenditure on health and low levels of global health security score contribute to COVID-19 related deaths.

CONCLUSIONS: Demographic, institutional, ecological, health system and politico-economic factors influenced the spectrum of COVID-19 infection, severity and death. We recommend multidisciplinary and integrated approaches to mitigate the identified factors and strengthen effective prevention strategies.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalBMJ Open
Issue number2
Publication statusPublished - 18 Feb 2021


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